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Home My WebLink AboutBLD-19-001887 BUILDING PERMIT APPLICATION :, -.---1-:-..: q ` " ,e• *„? S ",.:APPLICATION TO CONSTRUCT,REPAIR,'RENOVATE-CHANGE THE USE.OCCUPANCY OF, a tE: G ';.OR DEMOLISH ANY BUILDING OTHER THAN'AONE OR TWO FAMILY DWEWNG.;; 0 �1 $ Town of Thrrnntuh Balding Deportment' _ ` r• ec f.✓ - 1146 Route_8 . lanninnh MA 02(64-t492 , Tel: :-50&398.2231:ext. 1261 Fax 50&398-0836 - ', � -Office uu On,y, Planning Board INormatrort Assessors DepaMxM Inronm6on ,- Permi6? . • °00 hi3 J Pw,,ypt' ho , 6 Permit Fee`. $ - t Edorse, t oats Yom/ Recording' Datt New - osit ReC'd.:I- 2 ;irate p�NO. ': .1 1 Pioperty Dimensions: , t Dep - ; Net Due . -, S j f ;;: 94h_er , , ' ,.:La Ana(st) -.Fromm(fy , ,,,.Lot Covera.{,. ...This Section' for Mee Use On ; Building Permit Number = Date Issued. . ::1''''•::-:•. ,-1, r Certificate of Occupancy l3ignaturel� Yj:: r5: `� /� . :-;:.Bufidkq Otedai,. Odr . . is ° bra requlnd{ Section 1 -Site Information 1.1 Preprirty Address* - -.r . - - 1,2 Zontrp Ininrmation. _ - - , 976 Main St, Rt 28, South Yarmouth,,MA 02664 •; , M Nochange x y ' ..;'.. :.• , .- ,r - ., ^ _'rn._ Zoning District'2,-.:-.:1.'f-;:ti. Proposed Use ., 1s*;DuildIngAtabonet.'(ft) : .' . . t, ,:''....11:7.J.;2. , Front Yard t .::7rtSideYards ` .. - , '.RearYard• -_ F y'. Required. '.'Provided = Required Provided^ tii,Required Provided i- ti - � ' tA'tMri.r iuppry(Y.O.1..•m IO.i 6q 1:5 Fbod Zoo•t to n+W... - , Convn•rxs ^'siPub-c lZ .;Private ,_Zotftc _BFE'" _.. s. ^: Section 2- Property Ownership/Au horized Agent J . 1 OwnnetR.eordr' l -', . - , - . - » - I rEasterRealEstatex;,,;,.''_ ,.120�PresidentlalWay,,Suite300 - !, Name(print)- _ 7. Mailing .. . .e:t,::: ,�,i See letter 1 ••:;*--.:,- : ` _ • - "508=679 5733r: ' i, , Signature', Telephone n Ter ' e�'t Emaii Address• t 22 Authorized Agent --. t . _ . Jason i-iunn,,.', W``i;': :,•i - S Elaine • 319 Elaine's Ct Dodgevtlle,.Wl 53556• . g , N (piing,'' • MaNngAddress. ;;:-.7'•,';.C.:-". �' 608.407 9087 ` , - '' S�aa - P4 „,r:-.-9:9,-,,,,,./.1::-.:-,-,::.Telephone ,Fax _ ,,1 Email Address Section 3's Constructlon Services , +' ' 3.1 Lle.ruW Canetrrictlen Supsrvif.rt NotMdkahle Christopher A Soutter r i, ` • s t _ 1 s3 th n_R•'-d, Barrington, RI078400 ,� Lceas,Number a - - C07840- 0 Addre !/ F /{® (401) 2359042 andy@votzebutlea,, E■pirationDais , ll + , - Signa JR ,.;:; . Telapftone . �.-., -- 7/3%2018 r - , Emait�d�t �` :D. 12018 L } � ` e OCTacr :t: ; • ,.. BBr___I • '... • ,ar” .�: ... .,,. ' 3 ,.- 4; 1 , , , UILDING DEPART, - q+lEfl ill:se, 'g`' ` .�,,z•.... ..F.':.. ......_moi' .._.._:,:c;, , 3.2 Registered Home Improvement Contractor( - Company Name' _ - Nd APP&ada _ Repisbatlon NumWr ` , . , ° - ... - EtRirarmn Oats t, Signat Seotton 4•Workers'Compensation insurance Affidavit(MAL c.152 8 25C(8)I Workers Compensation insurance.affidavit must be completed and submitted with this application.- Falure , ' . to'providejtils aftidavit`wil result in theedenial of the issuance of the building permit.„,- SignedAffidavitAttached:'::Ye'sE.t :No..` 4 3/::::..:',:::::; :4,:2-:•.;-7,,. .( .. . „ Section 5-Professional Design and Construction Services-for Buildings anctd Structures Subje , , " - ' to Construction Control Pursuant to 780 CMR 118(containing more than 35,000'cl of enclosed space):: ' :fr _l. Section 5.1 Registered Architect :.;'. -.::',. ..4 .- t ': ...' Nicolas Velozo „ . iaaApvn<+� ❑ Name(Re ; ;_ ..,.126 Cove"St'Fall River, MA 02720. `' ' Ri94sna nN""'°ar,951281,r Address "'s•« .`: ;;,,r ,.C.. f-r: ` 508-679-5733 E.ph'an°eDate 8/31/2018- - Section 5.2 Registered Professional Engineer(s)( _ _- .. .r• , �:. ,,., . , -, Ana d Reepa5tMY_ `. Address -.1 -, . r RepisnSon NWa1M ,,. .. t r . .¢ • i'.,:Telaphnn", E�heart Date. -- , -. .. . Slgnattua•- ., ... ,. .. . . - - .. .. 'r -�• - - ` - Ana aRepaW oriry'r -. .!L I Address , - ° RegaV1 f NtSItC ... lex` }'a .t Talephme _ E` tri %Dao 3- . . . ,., ... . .. .. , . , 4 !p•_ .-. .: r ._ - - Aha d Raapoataey-, > Address-• . .'�..- . . - . .- = RaWo'tNumbr ' .- - :. _ .. . .Teleptnns ... ,•, Eclntlon Date: , . .,..., . .. Y Signature Name - Ana d Rapmati t1 - - , Registration NumbY x- Address • _.,. t I I�katbn Data I. ' Y -. Signature Telephone. , 9 ': Section 5:3 General Contractor(- , Votze Butler and Associates. A' NotApplkabIi 0 , n Name - ' - _ _ 1 Person$ y"'•'„163 Mathewson,Barrington RI 02806: ' w C Address-s ,, 401-235 -9042' .. : -.f ` - -y Signa i • ' Section el•Description of Proposed Work theca an applicable)! .•. . „ New Construction-. Q. '(lor multiple Emily only) No.of Bedrooms r' - -=. .(lor muinDle fatty only) No.of Bathrooms _______ Existing Bldg. 0:. 'Repair(s) 0 `, ;'Alterations.Q •Addition'0• —......777.+.0 , ' . .'.,==,:1,,'„- ' • • Accessory Bldg:,.0,(T ipe „..F - Demolition- ,',: . Other ::',Specify:' ,: ,' ' Brief Description of Proposed Work - , ,:-._1.-,- -._ - +.rww!+n,+•rp-tnsfr'(+`$•h,.rfr - - - t - - - - YCHANGE,OP GC•Interior`remodel of an existing.CVS�to include new:fixtures and ''' -finishes along with improvements to accessibility:Areas of,work_include salesfloor,,,T,, `'bathrooms;photo; checkout,•coolers; m among ; other areas:,: . :• . 1/4 ' ' Section 7.-.Use Grog and ConstructionType f;=: w. , i_ - BuildngUse Group_(Checkas'appfieapable) Constrin:tionType, , A ASSEMBLY' .. Q"• ,;iMM1 (� � �iMa Q A7- QrM1A� Q^i, . AJ Q - -.A3Q : =7B•? Qi c...;-,:„ . D EUSINESS_; :• Q,. .-. -- + - , ,�,d ..aA ' ro. '",-..' .`. F,,:FACTORY: :'.. QYi r`".:_"•i- .:» F-1 Q. '- F4 Q.'- `.' , . ._,, ;a aC t Qt;.';,t.; ,." I::INSTITI!TIONAL �❑•;•l H, Q. _ . , Fa'Q t 7 O ` Q - R-RESIoemsI, ' ❑ - '�R•1 Y, - .. R-2 Q. , &a Q r sA, ❑- - - - - 8.;-STORAGE K' . Q ' .,. - `.Si Q . S-e'Q• ,. . .. , es."Q . .. :. 9' SPECIALusa: Q .._ •__SPECIFY:' -:_ , - - C+�. . _--. .-. _t•:, Complete Complete this section If extsttng building undergoing renovations;additions and/or change Iritassel:r i',k:.?-°:; F:,:`. ;..-:- ExIfing Una' 'Mercantile-- Pharmacy , ti p,-;aea us, -'M no change,._ Existing Hazard bdai 780 CMR 34 '-. , ' -: ' - - • t Proposed Hazard Index 780 CAM 34 -. • .. :': Section 8 Building Height and Area .• .• •m' .. -. Bufdirq Aru ;._ .. ..Existing Pf applicable)' •• - . ;Proposed , .. Numbed Mora a sbtq r- . dcaidabasedbnttevsla _. <, -, 1. no_ChangB:: t'roorAna Per RONNq . _ -i., ' - - - - ti. • - '•=9,975:no change -::.- .- Total Area Ag Floors(sf):' 9.975-no change. Total HN (ft)-'._ :_„- Height :' .. change „ r` Section 9•STRUCTURAL PEER REVIEW(78oCMR 110 11) •''r , '.: .!:,' . .. .. Independent Statham!Engineering Structural Peer Review Required:- ..'.;Yes ••• '0-- ••.: NO;2. "'. SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN :' OWNER'S AGENT'OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ;as Owner of the subject property, , hereby authorize to act on my behalf,in ea matters relative to Work authorized by this building pen-nit Application::: - ` SlgnaNn or Ovmer .. ,. �, . .. Dena . . � '• y 'i SECTION 10b OWNER AUTHORIZED AGENT DECLARATION I, .. . .. . ! Jason'Huhn i1 ;as OwnedAuthorized Agent hereby declare that the statements and information on the forgoing application are true and acurate;to the best of rriy knowledge and belie(.'" Signed under the pains and penaltles of perjury- JasonHunn _ . Section 1t;ESTIMATED CONSTRUCTION COSTS: - -- - item - - _ Edmate4 cccl iDcllanl to ba -- . i':, i'-.:t: " ''C. 4 - _ ddtip4tadbypen fl1pfant, . t • 34;000 _ - a patriot 6700_ • f.. .. .. � - 4.Madenkal tFNACi-. .- . i ra.Thtal.i1.2.3.4.a):.- ,40,700 - =�•• +- ' , : Check aeiow - - " , ❑• Conservation Commission RSriy (if applkable). : •a ❑: Old K)ngs Highwej!S HIstork al r Commission approval e- (If appiidable) r- ¢ F a 2,,,....,--: t' - V F , ;„-yr, .21. ,4 4' tip. - •'F - t �♦ F V '.4 l' 4014 - -, ..� _- - .`. >.....,__....�_...�. ..,_._ ..... �. s ...... 4 ._. .. - ..'.-�.....- mar-..x..b. ...»,.._�_<. •v, The Commonwealth ofMassachusetts Department of Industrial Accidents p — t Office oflnvestigations ''•, ' 600 Washington Street `-r- `. • • - Boston,MA 02111 •...-.7.•;.,..• ' •www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information . . Please Print Legibly Name(Businessiorgaaiationllndividttal):Votze Butler & Associates, Inc. • Address: 44 Stedman St Suite 8 • City/State/Zip: Lowell, MA 01851. Phone#: 978-459-7600 Are you an employer?Check the appropriate box: type of project(required): 1.M I am a employer with 26 ` ! 4. Q I am a general contractor and I employees(full and/or parttime)." ' have hired the subcontractors . 6. 0 New constriction 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. D Remodeling • ship and have no employees These sub-contractors have g• 0 Demolition working'for ate in any capacity. employees and have workers' [No worker'pomp.insurance comp.insurance? 9. 0 Building addition required:] , . 5. 0 We are a corporation and its . 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work ± officer have exercised their .. 11.0 Phunbing repairs or additions myself[No worker•co ; right of exemption per MGL 12.0 Roof repairs insurance required]t : .' C. 152, §1(4),and we have no 3 a.1_1 I am a homeowner acting as a employees.[No workers' 13.0 Other general contractor(refer to#4) . comp.insurance required.). . • `Any applicant that checks box el must also fill out the section below showing their workers'compenutio4ofiey infbrandion. t Homeowners who submit this affidavit hidinting they re doing at work and then hire outside contractors must submit a new affidavit iodating such.: . :Contractors that check this box nmst attached as additional sheet showing the name of the sub-contractors and state whether or not those critics have employees. If the sub-coouamats have employees,they must provide their workers'comp,policy number, lam an employer that is providing workers'compensation Insurance for my employees. Below is the policy andfob site Information Insurance Company Name: Trevelers Indemnity CCS PoGcy#or self-ins.tic.#: US- 8K30301A 5/30/2019 • Expiration Date: Job Site Address: 976 Main ST, Cit/Staterflp: South Yarmouth,MA 02664 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year'... 'sonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day a_ainst thr4.lator, Be advised that a copy of this statement may be forwarded to the Office of Investigations of the .t f. .ce coverage verification. • wr Ido hereby c ay• i rad= the paints • penalties of pedury that the information provided above lt true and correct • Signature: Date: 6/28/2018 Phone# 978 a 9-7600 IOficial use only. 'o not write to this area,to be completed by city or town ofdaL I City or Town: . Permit/License# Issuing Authority(circle one): - • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone el ................wwq, VOTZE-1 OP ID:LL ACORO" CERTIFICATE OF LIABILITY INSURANCE DAD Y) �� 0 06115/6/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 978-686-2266 NzeCT Lisa Lariviere Foster Sullivan Insurance PHONE 978-686-2266 FAX 978-686-6410 163 Main St (AIC,No,Ext): I(A/C,No): North Andover,MA 01845 %lass:certifIcates@fostersullivaninsurancegroup.com Foster Sullivan insurance LLC INSURER(S)AFFORDING COVERAGE NAIC I/ INSURER A:The Phoenix Insurance Company 25623 INSURED Votze,Butler&Associates Inc INSURER B:Travelers Property&Casualty 25674 1075 Westford St 4th Floor Travelers IndemnityCo 25682 Lowell,MA 01851 INSURER C: INSURER D:TRAVELERS INSURANCE CO 19046 INSURER E:Evanston Insurance Company 35378 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER (MMIDDNEYYYI IMADIIDD/YEXP YYYI LIMITS A X COMMERCIAL GENERALUABIUTY EACH OCCURRENCE 3 1.000.000 CLAIMS-MADE El OCCUR CO-9K143264 05/30/201805/30/2019 PRMSEEORENTED $ 300,000 CONTRACTUAL EXP(Any one person) ,5— 5,000 _XCUCOVERAGE PERSONAL a ADV INJURY J 1.000.000 GENL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000.000 —I POLICY X PEB& n LOC PRODUCTS-COMP/OP AGO $ 2,000.000 �II OTHER' $ B AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,000 (Es accident) $ X ANY AUTO _ BA-9K110940 05/30/2018 05/30/2019 BODILY INJURY(Per person) $ - AAgTU�Oq�SONLY SCHEDULED AUTOS BODILYOINJURYTYpA (Perace/dent) $ X AUTOS ONLY X AUTOS ONLY waiudanU MAGE $ $ B X UMBREW LUIS X OCCUR EACH OCCURRENCE 10.000.000 EXCESS WIB CLAIMS-MADE CUP-9K165871 05/30/2018 05/30/2019 AGGREGATE $ 10.000.000 DED RETENTION$ $ C WORKERS COMPENSATION X STATUTE PER ETµ AND EMPLOYERS'UABILITY UB-8K30301A 05/30/2018 05/30/2019 1,000,000 ANYAQN� p�P`ROPREIIET99O�RRq/PARTNER/EXECUTIVE Y/N E EACH ACCIDENT $ OFFICEtorylnDN)EXCLUDED? NIA 1,000,000 E L.DISEASE•EA EMPLOYEE $ If yea describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL dSEASE-POLICY LIMIT $ D CRIME 106255368 03/09/2018 03/09/2021 LIMIT 3,000,000 E POLLUTION MKLVIENV100988 04/20/2018 04/20/2019 LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached amore space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Rt 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ®1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • vpIZE•Burtfq VBA Andy Soutter s/BA ' VBA Rhode island Branch AssouAScc Tel: 401-235-9042 Far 401-769-6573 CONsrlUCT1oNa Mobile: 401-255-3633 - PROJECT MANAGEMENT E-mail: andy@votzebutler.com MA: 44 Stedman Street,Suite 8,Lowell,MA 01851 RI: 108 Mason Street,Woonsocket,RI 02895 Massachusetts Department of Public Safety Ili Board of Building Regulations and Standards License: CS-078400 Construction Supervisor *fr 4 CHRISTOPHER A SOUTTER k t , 165 MATHEWSON ROAD r".1 BARRINGTON RI 028064 : i°"•• 7 n , ` 1,4110 • M-^c l.� Expiration: - - Commissioner 07/07/2018 • '.:tc,-•.. .•-•, _; .`. •:••-• •• 'III': -11"...''',i 'I' 1:1 ''' - .',..t 7,1.---; ';' '' ''''' ' ':•''.;; r. ' .- ;." 1" " I.': l' 'LI.' 1.:-::. '..., :.'' ';. ,'" ''.L. '1.-:.:7 ..;:./7-45i I • COMMERCIAL ONLY...;4 BUILDING PERMIT':'.1:::::.:, ,. T.,,,:±44... ;;;:/,:::•:: ',..-(7,-,-,,,,:-, _ t• ' ' ' • ' ' •••:- • " '': 'r- 't 'APPLICATION REG'ULATORY APPROVALS:NOTICE of Proposed 976'Main•St Rte 28 . ,. ' ' '. . ,..„-• ,.. ,•,.-..,...- -........ • ,.,. ddress .' :-." .. • ' -- • *. - .• ' ' Scope ofProposed Work:-••4• Interiorrerriodelpel'.an,i.:-eitirig:?CyS,,,t;'•;•.":ic.C';':,:..1":1_' Yll-ii .!;• •..-',.•: "i• : : t'r..•!- ",- '''. . "-:::•,;.,,-',,sfore to Include new fixtures and finishes,along with improvements In accessibility. k 6/28/2018 ., . - • .' ' ''• ',..- Based on.the scope of work described nbOcre,the:applicant is required to obtain approval + ' ffs from the following departments as checked-off below::-:::7 .1 .DitriAis „,.. •':':--.....:;;::',:,1. :,-;[-„.:.,,.:`,:f:lin, health Dept A 508-398-2231 ext. 1241.45;, ; -A4,T-:4. ,-:‘ 4...: :::,.; :.: ,:: ':: : ; .4,...; ,,,,::;742.:,•..,;::::!,:....,:4: ••••••':' l'•••i:'''''''''4'.".-: '''''•••:ff-'.'I'C'nr i rvatiOn tontni Li 508-398-2231 ext. 1288 ' ; ':' '" /E 4•'• : ' . ' 'c"... ..' f: ., '..4 I' ',";--7 4 -T.-,.; _ WateiDejit.4:,:.99 Buck Island Rd.phone no.:5087771-7921', f.“--.2 •••--' -7,--,:,:;---:-.--:::,±4t,,5.,:-.,;#,:::•,;, '1.:744-,'?,4 1..f.:(4, 4-: -L. : ;--' ',';'- -7,''''''''''' vr'''''.'"*:::. •:‘,;;'-';'.2;7"';',..''':',"(V;t;'''':- .7',:::.;,..,;.,.,„ fl'''''.1" ''(r It!, 1:',',' ; :1,c...: ";...,;..‘,....:,.. ,:,....;' ,; '...:.?"-:' r''' ' .i,;.E.,'... '_,:-.'„g t''''''' .;:.;'1::%';' :-;%•.'2';:''T"';'' '. 014.ifing111 wy.H.-.isidom".'in:A:568-498.12iSl'exi:i292',''':.:-.--;':;:i,;'''-'-'-'' •; i ',.2.,•:,:•.;:::i','",.;;•:•'•7.tf,ft.,,',II, -,c;:::;:c,',1 4 ril...11'*--E::':.•L:1'il`tink 1:::::?4. Engineering Dept---*.: ie 508-.348 2231 •ext. 1251it.; 2 ''' '''''''' ''' •'''''''' ''' ' ' ' '''''' --s•cf:'''''''''' ''''''•c"f';',•"":7•44-i'•:'11 4” --; ' „'• - r - ., CP47., :r. .. ; : :-: :'4:1.. '-'?•;,, :::Y:'..-..`..- ,. r-:, ,:4 .. : .5 :;._ ,::,.4„: -.ii;, ...•4....; )::,...-1 Main St.St.'83 .-:... *...41 -*/• t:' - -ri.:.;1...- . --I,T.' - ::. -• C.:.: :L'-:;'2;'1'L.. -. :4" • ''': 4,'i :i.,...-;-4[:::::...:'',.::.;; ;',..:::'; • D i ! Dept—Kevin Thick/James Armstrong,96 Old 1;4:;;„ , ,,... -•,..,:,..:, 4„:4„;;•,;4f,:,.",-,..4..„„.„,',,,,,.,;!;4:.1 '''''S'''''r:1;1•''-•'''':l''''• •••'' f "'Fire • '- - - ' 'appointment 508-398-2212- - :• •••:, - ;: ' ±:: -- -•-—; .4' s.4 Note: Please call Fire Departmentfor.ati ________ :•i•,4.‘„,&:,'';...4 ,-.4::: "";,'".'''-.Y,f,',41-",,I,•':',.:fi's.'''• _____Other f:.'",•;;;;c::;,4,;..;:[4.:::•,:.;.1.:.„,: ;-',":;',L,'',-.:::,4;,"::: .,;:,!, ';`,z,."1:::t-i„,1•.''.f.:',f ±-...,'":„:•:,,,,,...4.:\f//f:::::-..-.:.:4;;-",;',--It; -,.,1-,-„, ';;;;;:,:147, ;,..;••;.:rt;'.:':-,:-, !„ sc:, t r:s'1:-::'-s•-lcs :'s::s"'si.'l.::'1.:•-;7'.''-.'''' ' ' 1 r ' : ' "''""t:',14', ..-..: si;'•',' ...'"'"±i's71.' .1:‘-''''sY-1;:'''';:r-1::::::,,:•Apprepriate plans and/or application shall beprthrided to each of the departments . .. ...._: checked-Off above. Each of these regulatory authorities has their own requirements.± :,;;;,,,-,4;‘,.,,;,..,..:,...14•,,,,,, ,,::: •: I'4'.. t4 ::: :•-•!:_.:,4,,,,;outside the jurisdiction of the Building All applicable approvalishillbec;_.:-,-4';::,,,,,, ± 4.„-:,„„b• l'-:-•:-'''-!..',...•?:;:,,:,..;•4'..,":„: obtained prior to submitting a building permit application to the Building Delik -'-7--- -.-'--:;74”-.7Cr'. -;,:-:-',`''- ;.:_';'' '." .•'..--; ';' ' -" fu:r-:.-.7.-.2.,.';..'-',..:',:f: • J.. .--; .!..:';.; '... ". '*;:'-'--,:-. - i' t. "7- -;.'''. : '7. ±;:;:;'_-;;;T:'‘;'...1,:-.:L..,,t... ::. ;', '•:, :.'1, Thank you •„.:r!:' .',:A].i."-"1,',2'''''. ‘;'t..•:71. '....:''.' '74, (II."'.''''-'i",- --;,":',i.r:."." '''';',-;. '."'''',': '-.:t r. ..--.4..-„%.,'" -.,,,•- t Recei t AcknOwledgement:;".y.!--7,:crt, 6/28/2018'';;"-:•,,,:,,,--.1•:.':.1;;-;v:' .,;',.'t,4 .t<:-:!.*:-. -,:-.17.`). 1:-- ••••:`tU','-'.. .:2-` .1.1.,"1:, '....:11. f_, • , :....;::::t: 7:1 '2-1c.":`1,_-::,h:1::::.:::,:::;::::/ ,.• .% ' : 4 .:::;.;::,if ' plicant's Signature - .:::' :y,. • : : 4: ;.-,f; ,_';''.- ;IC ''''..:', PSC ''.;''.;,,'..',..„-li.':',., l'..,-,c'',:',..r,-,..? Lr.,:.'..h1.:•"' -. t„!. ikl;...:,, j...:Rev liee2015.'s:'' ;:'f;" : ''': ,1:14.•44: ''' c-11-•-•.-?" '. ---:'•''t' -'-' ::‘'ll.•L• :' ,:fi.-I 4' .' -!..• 4. •::. ..:::'.:;--;„:4:".;-,f•' " ',447,--;"•;„'',.4-•:: ',4.',' ' 7.',f.':, ., •.:,::' . ,, .•.:',;,,;,-. ; ;iii.!-,1, '', :::,;: j: ...:;.:,:',. , :",...:4-4,.:4".-11:4;' sit'L.t ,,i:::::;7.:Q1.;'..):'...:.y2t:,..;.J:: .-';'.; 1^:' .,;::'5-*-'',;'•,-'1.1:. '41';.l'Ff2'.1'..r.71'4'.':'''.=, '..:.;,,'...):44.:71 : .;1. 1.2.;•;.„?..';.....;'-:..:*..gs:1.:F4'474.1T::::::::-12',..,..1'; .:;:---i;-„';'.i,...,;.,(.....:.=i1:1-.:....4]:,....1-7 4.,1-,.::',-'-'..•-:',','4tic-i ' v o yR BUILDING PERMIT APPLICATION , j . ,I r..,,_, ( Z 4 - APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGETHE USE.OCCUPANCY OF, it, C 4 OR DEMOUSH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING., '. t. .e4 �T ,Tnsvnisl'l:srnintithBuilding'Departmerst, i, I'1•16 Route•`28•• Ytrmaidh,lurk 021iti4%•I`192- w ` ; -;',Tel:-_ S0&398.2231 exit:-1261 Fait SOS-398-0836: - -- • •,:Office the On ;' - Planning Board Information Assessor Oepn+trnent lnlomudo R C ttti0 �° �Dfte_• �"Npe -" F PermitFee S- Ig; EndoremerDan `f , �y. �82D18 .. .. B-----•ng Oate - o Ne j5.: ,. A Deposit Recd. i,—.3 s Date Ran Nti 1:4 Propefy 0tmeestoins BUJ S. A r Net Due _ $ SSo.�,-3c .-.H .. - .. • Lot Area(st) : ... ;Frontage IBJ , :: - Lot Ceeerape ,-.:r'.... 5,rj5, This Sedan for011�Use Ony: •• .. ' t'.4 Building Pe ( Date Issued. r . .> � r "' =CertlftcateMOavparxy : Slgnattire reque.e sectton t- sne Intorrnatlon + 1.I',P+opeirtl Addreaet .. - - r .- - - 12 Zdninglydomutkn - f•.!,',-e.:1.1.•;2-','';',., '976 Main St.,Rt 28, South Yarmouth, MA 02664 u-No change :,. - Zoning Distdct + Proposed Usa t ,' t`. . ,a 1.7.Building Setbaeke It) '.,`° , 'SI': . .. ,,:'i_- g. . . ,-Y .,. :},-. , - Fnmt Yard -Sade Yards- ® S Required; Provided . Required Provided rid`,:"` t':-t Pronndeic r e syr , ' , j:. - 14 Water Supply(M.O.L Q e.40.S. 1.5 Flood Zone kAdmatorc -= Cortvnrkc UC1 t -4[111,1 t .Publt3.0✓ Privet. zoriz BFE f K a ¢J ; "' ; Section 2• Property OwnershlplAuthoiized Agent • 1•..Y __ ,__ _ -s r t ,y _ .t - t _ - , : : ;-EasterReaieetat e . ",•, _120 Presidential Way,'Suite 30-0_1.,--,- .- ' 1 .Ep . Name(pdnq Ma f.> •:.;.,.-;," • „See letter .. 508-679-5733,_ - -: Signature :; , • - - - 7ebphorne _ , Telephone EmallAddress -1 r, 2.Z Altlhorfzed Agent:I ;,, t '. :- yt 'k` ' , :Jason_Hunn :: 319 Elaine's Ct;Dodgeville, WI 535564 Mafluq Address: + 608.407 9087 w4! lure:,)-,t-.- T.:,, ,Telephone ,, .Fax „ £mall Address ) (i,,-,;, ,- Section 3;Construction Services I' % '`� ''' ., ; 3.4 :ceased Construction Supervisor plot Applipahle Ron Aubin=. f „ 1,081 aiamond Hill d Woonsocket•RI 0289.5 ' uc.nseNum—ber w' ,£ ` � CS 056874 ,k� ':-...''6-:,,.I - 'raubin@tedsconst•ar 401=769:4285 ' ag,nnate • tt rx sl a ,elepho 2/7/201.9 i v y + . . � ♦ e ' •' •_.-;_,‘,.t-;.- ne re - i, A s a s f 7 r t -y- 't16L. a ; r + F : , 4 - - k1. 014 ..... `s: i i , OVER- 4i rt ,j.iit7- vi ,:-.?.:;1-.,5'. 1,1::"%-'2.:--.].;7. A f *.. ^t . .aa:M44,` ;5yu. i.. .a1;i, a. .., 1u . £. J.1 t. ..li .. i, zn`aB i h 3.2 Registered Homo Improvement Contractor ; _ _ t.;,•,:.' - Canpany Nn' __. -.-- 7.-:.,::<.-..:_ + -.- ._. - - . ,, - NMApperable a .:._ . = . Address - - - - - Wgistradon Numb.r - Section 4•Workers'Compensation insurance Affidavit(M.at.c.152 8 25C(aj J __ Workers Compensation Insurance affidavit must be.completed and submitted with this application::'Failure to provide this affidavit will result in-the denial of the issuance of the building permit. . :, :?Signed Affidavit Attached""Yes:, .:: :'. No • . - _ . '. t = Section 5=Professional Design and Construction Services-for Buildings and Structures Subject ` .` to Construction Control Pursuant to 780 CMR 11 6(containing more than 35,000 c.f.of enclosed space) 1,----. , Section 5 t Registered Archltect ...: ___.2 „ Manta ' -;'Nicolas Velozo - NotAwtreble 0 Maa(Raylstrantp .. - -°--- . -•-- ---- - -- ” 126 ecii,te St, Fall RIver;MA 02720 rat0f11wn°"g51281 - Addi.ressS.c-: r- 508-679-5733 =: ' Eggmbaltiam 8/31/2018 -.--- gnatun - -. •- e- Jeleprron -. _ _- - - ' Section 5.2 Registered Professional Engineers)I `..: .:-- ..- Signauas- - - �•�' ' r Hams _ - Arse at Rewasuay Address Regrtnenn Number - SlgnaWn Telephone E+sur.esn Dau i _ Hama - • - , _ _ .. ,___ - J - An.r1'iteSpaedOtlty y t } ,. SignaNn.:• .:,;,.;-.': . . 'Telephone rpi.u0n Dat.. . --'- --..,. . _ al ResponWy M1+; l..,. ' ' Address, Reght14bnNumber.;, ;:y,J;.: , . ', Section 5.3 General Contractor 27:._:_: • :Ted's.'Construction - :. _` - we sa 0 = company N.mst Ron Aubin, Parson ResponsiblikwConstnclbn 1081 Diamond Hill Rd, Woonsocket Q jj. • Address - - - - - :401_-769-4285- tl p .�ws - Signature-' - . _, TNeptwn.•:, .... . - - f,,^L - 2or4 -° Section 8•Description of Proposed Work(check as applicable)! L • - ' New Construction Q � (tor mumble family only) No,of Bedrooms" moose1(ra muootame,DsY) No.of Bathrooms't Existing Bldg. 0". Repair(s) ail Alterations a Addition Q Accessory Bldg. 0 Type ' t Demolition' Other - Specify Cr:- , --- ' Brief Description of Proposed Work :7 Interior remodel of an existing CVS to include new fixtures and finishes along with - % i.- iimprovements to accessibility. Areas of work include salesfloor;bathrooms, .; - photo,checkout;;coolers, among other areas:: _ _ ; - .:,-v_:,. ,_ Section 7•Use Group and Construction Type 1 --:':-: °: :: :: .. : —.. . .. -. ' . ' Building Use Group(Check as sppraapable) . ,Construction Type Th: . .. A ASSEMBLY `,r Q -Mt Q _ -:. --` A,a ❑.:_ _ ..4•7 01 ;' - to„-❑ �- : - _ .: -1",°1:::::— .A•4 ❑' - ''A3 Q .. -:VS::❑ - - - ' •._. . E-_=EDUCATIONAL Q. __,. - - - - - - v .. _ ..-. --ze_:=❑ -i:,_, fr PACIDRY. ❑: . , ',Ft Q _. F2 Q }-r .. ` . ZO ,❑•:".'.. . - _ :: H�HIGH HAZARD ❑-, "';....- . ,7A�.=❑ I INStntnlOtULL ❑ _-. 41 .❑ =: 4 =❑ la ❑ OB _ - -- . R-RESIDEN1W. Q- .._ 141 -: t•-. - ..,.n-a Q - .. .R-3 Q '•c _-SA _Q _ a: sroPAGa ::. ❑ .:... .,.. '- s•1_❑ -,. :'. ., . .S-a Q _ _ , , _ 'ee' ❑ _t. ' : , M=►axED USE ❑ _ : r .._,SPEOIFM .':__t: r -_ ._- - --`- •-- --- - - - •`--j Complete this section if existing building undergoing.renovations;additions and/or change hi use. ` • ; < T ' , . Existing the oroup: Mercantile'.- Pharmacy, -= : isroposedu`s.aroua: :M-nochange--t' Existing Hazard Index 730 CMR 94. Proposed - - - - Hazard Irdax.780 CSAR 34-`'- - Section 8 Bulling Height and Area I ' . .. -- _ _ __: . . .r-euikarq Ma .-, _ ....- .:. Edsling(if epplkabla). _ - . , PropoaW - . • Nunawa fano nada ----4 usa,efan.nrmrr.ta • 1 nochange;= .. _. - Total Area Al Floors(sf)''t;•':'. - . .,_ Total Hek�ht t4•) ' `,_ .. : ='> `-.. no change: . . Section 9•STRUCTURAL PEER REVIEW(7B0CMR 110 11) I ._.: Independent Structural Engineering StructuralPeer Review Required ` - : Yes . :N0.0_ ( - SECTION 10a OWNER AUTHORIZATION•TO BE COMPLETED WHEN.: OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT : I , ... . . ... ... . .. . . . . ... .-: • ,as Owner of the subject property Hereby authorize ,- • .,to act on my behalf,in all matters relative to work authorized by this buildingpent application. '-jt ; Date t) ( 3 a 4 OVER S ... .. .... n..a .. 1 �.. .._i..., a ....5 a......w. ... ., .,_.., ... .. _ .. _ s......, .... � ..-.k• SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION I..-.. - . . •- `•' r r °Jason.Hunn' : -._• ---_", - .'as4mier/AuthodzedAgent, ,_ hereby declare that the statements and information on the forgoing application are true and acurate,to Ithe best of my knowledge and beaef Signed under the pains and penalties of penury Jason Hunn J 5/15/201$ f •- � .a o.n.nA9enr . - Section It -ESTIMATED CONSTRUCTION COSTS, `, - - . - .-- , c ;., :. '"' -. --- :•, �EWmafedCortlOoll+islbtx_ --- '' , r .. -- `-�'-.- `, -mnPlalsdbYprtNtsPD�t. - _ - - . ... ... _ 34,000 oe 6 70 0 Conserveila�-Commis&on Ran f ` 0 ,Of applIcable) ❑.Old kings Highway&Historical Camndeslon approval " {I(appadabb) Y.y 1 t 1 _ 4 ] - v • The Commonwealth of Massachusetts Department ofIndustrial Accidents • Office of Investigations — e— 600 Washington Street • • "�a=`` Boston,MA 021 1 • •www.mass.gov/dla . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(s„smesaiorgssion/bdi�lduej:Ted's Construction Co., Inc . Address: 1081 Diamond Hill Rd - 44 City/State/Zip: Woonsocket, RI 02895 . • Phone#: 401-769-4285 Are you an employer?Check the appropriate box: -- Type of es!,project(required); LID I am a employer with 15• h 4. 0 I am a general contractor and I - employees (full and/or parttime).* • have hired the sub-contractors . 6. 0 New coastructiem 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. 17 Remodeling ship and have no employees These sub-contractor have 8, 0 Demolition wog for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Building addition required:] . 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing aU work . . officers have exercised their . . , 11.0 Pbimbing repairs or additions • myself.[No workers'comp.' right of exemption per MGL • 12.0 Roof repairs insurance required.]t- :: ' c. 152.11[41 and we have no ` 3a.i] I am a homeowner acting as a employees.[No worker' 13.0 Otho general contactor(refer to#4) comp.insurance required.} . 'Any applicant that checks box#1 matt lisp fill oat the section below showing theuwoa m'mmpmnfio413olicy hformadon. - Homeowners who submit this affidavit indicating they are doing an watt and then hire outside contactors must submit new affidavit indhcating such. ' .t ;Contactors that check this box mut attached as edditonal sheet showing the name of the sub-contractors and sue whether no those entities have t employees. lithe nth-contract=have employees,they must provide their workers'comp.policy=abet . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. InsCompanyNamr • Beacon Mutual Policy`#or self-ins.I.ic.#: 25515 . • ., 12/31/2018 Expiration Date: Job Site Address: 976 Main ST, • - city/.S'tate 'p: south Yarmouth,MA 02664 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hen ' '" ' by c /R der the p airs and penalties of perjury that the info/amton provided above Is true and cornet Sitmattue: Date: 5/15/2018 { Phone ft ` s -769 5 ' Official use only. Do not write in this arta,to be completed by city or town officiaL City or Town: • Permit/License# Issuing Authority(circle one): • • 1.Board of Health 2.Building Department 3.Cltyirown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: • fl • ' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-056874 Construction Supervisor RONALD TAUBINr ' g MI.DIAMOND MROAWI1 "- FIRST FLOOR - " -. d WOONSOCKETRI 02896 :.1 d grl>:f "%,7,f 7 Oita•-•-• Expiration: /Commissioher • 02/0712019 l • I ' Initial Construction Control Document t * ft To be submitted with the building permit application by a Registered Design Professional ' for work per the ninth edition of the ._t Massachusetts State Building Code, 780 CMR, Section 107 Project Title:CVS Store #00735MA Date:May,11 2018 Property Address: 976 Main Street Route 28 South Yarmouth,MA 02664 Project: Check (x) one or both as applicable: New construction X Existing Construction Project description:Interior renovations and accessibility upgrades of existing CVS,as well as installation of new finishes throughout the entire store. I Nicolas Velozo MA Registration Number: 951251 Expiration date: 8/31/18 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection Electrical X Other:Entire Project for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a "wet" or ,EoARCH/rte electronic signature and seal: y oys a VEf 02,0'. ' U Phone number: (508) 679-5733 Email: nmarques@starckarchitects.co ••A Building Official Use Only i � � EAITH OF PS�' Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version 01_01_2018 'ACO d CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) kea.� 01/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES • BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms end conditions of the policy,certain policies may require en endorsement. A statement On this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CON)ACT Patricia Bourget NAME: Keough Kirby 1PHONEEms (401)769-8100 I{Ail,Nor (401)756-4973 957 Can Ave ai oArese: pbourget@keoughkirby.com INSURERISI AFFORDING COVERAGE MAIC e Woonsocket RI 02895 INSURER AI Arbella '588 INSURED INSURER B I Travelers P80 3548 Ted's Construction Co.,Inc,,DBA;New England Retell Maintenance INSURER c t Arbella Insurance Co. 1081 Diamond Hill Rd. INSURER D t Beacon Mutual 3490 P.O.Box 843 INSURER!I Woonsocket RI 02895-1504 INsuRERP: COVERAGES CERTIFICATE NUMBER: CL161529527 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR ADUL SUER POLICY EFF POLICY EPP LTR TYPE OF INSURANCE /NSD MO POLICY NUMBER IMMIDDMIYY) (MMIDDITYYY) LIMITS —' X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 DAMAGE TORENIED 2500 CLAIMS-MADE x OCCUR PREMISES(EP occurrence) 1 0,0 MED EXP(Artyenepanon) / IQ000 A _ 5500087986 12/31/2017 121312016 PERSONAL I ADV INJURY 11,000,000 GGENEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 C POLICY 0 Tei 0 LOC PRODUCTS•COMP/0P AGO 12,000,000 OTHER: S AUTOMOBILE UABLITY COMBINED SINGLE UMIT $ ',000,000 - (Ea @cadent) ANY AUTO BODILY INJURY(Per porion) S B OWNED x SCHEDULED 8A2544C151 12/312017 12/31/2018 BODILY INJURY(Per etdden0 i AUTOS ONLY AUTOS x HIREDUTOONLY x AUTOS ONLYY (Par ssccidenIOAMAGE 1 Uninsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 ' C x EXCESSLUB CLAIMS-MADE 4600041841 12/31/2017 12/31/2018 AGGREGATE $ 2,000,000 DEC I x RETENTION S 10,000 $ WORKERS COMPENSATION I SEATUTE I x ER AND EMPLOYERS'LIABILITY DANY PROPRIETORIPARTNER/EXECUTNE YNIA 25515 12/31/2017 12/31/2018 E.L EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED' (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 500000 If ye@,daunt.)under 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I `• DESCRIPTION OF OPERATORS I LOCATIONS I VEHICLES(ACORD 151,Additional Remarks SOMduI.,may to Meshed a neon span Is moulted) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTIORIZED REPRESENTATIVE , l 4 tor:,... Q, ; r\• ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD • • • • _ Al •. jk WILLIAM STARCR Y ARCHITECTS.INC wcoWnnn immix kwcicxw ns map ...��.,.w�www:mm CVS Refl.ity Co. May 8,2018 Eastern Real Estate,LLC 120 Presidential Way,Suite 300 Woburn,MA 01801 Re: CVS Store#0735 976 Main Street,Route 28 South Yarmouth,MA 02664 To whom it may concern: CVS has scheduled a Specialty Project at the above-mentioned location.The scope of work identified for this project entails installation of new millwork,and new finishes throughout the store,as well as a new cooler.There will also be miscellaneous accessibility upgrades at the entrances/exits,and restrooms,.There will be no exterior or structural work in this project,and the store will remain operational throughout the duration of the project. I have included a copy of the floor plan for your viewing.In order to obtain a building permit,we need your consent. We would appreciate your signature where indicated on this approval letter below.Please return it to my attention via fax or email at your earliest convenience. If you have any questions or concerns regarding this project,please do not hesitate to contact us. Sincerely, • Nicholas Marques nmarques@starckarchitects.com William Starck Architects,Inc. Phone:508-679-5733 Fax:508-672-8556 I hereby approve this special project. (Print Name/Title) (Authorized Signature (Da e) I MGL AND FIRE _ _ _�,� TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. • ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY �� • OF"AS BUI COMPLIANCE. •� DATE: s/n/t£f SPECTOR YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: CVS Pharmacy Remodel Address: 976 Rt 28 Contact Name: Jason Hunn Phone: 608-407-9087 Y NO NA Subject Regulation E S x Access for Fire Apparatus 527 CMR 1; 18.2.4.1 x Building Numbers MGL Chapter 148;sec 59 x *Flammable gas/liquid storage _ 527 CMR 1;42.2.2.1 x Fire Lanes 527 CMR I;22.3 x *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2 x *Hazardous Materials Storage 527 CMR 1;60.1 x *Kitchen Exhaust Systems* 780 CMR,527 1;50.1 _ x Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28 x Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;, 527 CMR I; 13.7 x *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1 x Use and Occupancy(FH Building Class) 780 CMR;302.1 x Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-1 x Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1 x *Upholstery 527 CMR 1;20.6.2.5 x *Trash Containers 527 CMR 1; 19.1.1, 1.12 x Any Hazard to the Public Chapter 148;sec 28 x *Curtains,Draperies,Blinds 527 CMR 1; 12.6.2 * YFD permit required-depending on occupancy and submittal *Per 780 CMR 901.5, contact Yarmouth Fire Department for acceptance test. *Per 527 CMR 1 13.1.8, a permit is required from the Fire Department to shut down any fire protection system. Description of planned project/other requirements: Interior remodel; Compliance with the following: 527 CMR 1 Chapter 16"Safeguarding Construction, Alteration,and Demolition Operations." 527CMR1 Chapter 18 "Fire Department Access and Water Supply" Plan Reviewed By:Optai ctor Date: 37//7 ha– Copy for Applicant C Copy to Building Department II Copy to Fire Prevention Entered in Firehouse I—I Final Inspection ' st ! . Q Letter of Transmittal V ' STATE PERMITS,IRC. MIMI12 Mtn 319 Elaines Ct. -Dodgeville,WI 53533 608/319-2096 * fax: 608/319-2011 www.st8.com Date: 5/15/2018 To: Harvey Trieff-At Your Service 649 Alden St Unit 324 • Fall River,MA 02723 Phone: (508) 677-6700 Attn: Harvey Trieff Re: CVS #735 Street Location 976 Main St. Route 28 South Yarmouth,MA Proj: 834000 We Transmit-VIA FED-EX ITEMS : - 3 sets of plans - BPA - GC info (insurance, license, Affidavit) -LL Letter - Initial Construction Control These Are Transmitted : -Submit Copies for Distribution# Remarks : Harvey, I already emailed a coyp of the plans to Capt Armstrong with FD, you can reach him at 508-398-2212 if needed. There is a small building review fee that you'll need to pay, I'm unsure of the amount. Building is located at 1146 Rt 28, South Yarmouth. /��, I �'� p Signed: (- �\ C-"i ` f�A / i�.11( " _ , Q�?'(�LJ Jason Hunn x417 Jl�"" �W J Page 1 of 1 ant 5-1 id/� 319 Elaines Ct.-Dodgeville,WI 53533 66S/319-209 -Fax:608/319-2011 -www.st8.com lerYli MGL AND FIRE ;;� TOWN OF YARMOUTH �7/Pa /Y \ REVIEWED FOR CODE COMPLIANCE. � ERRORS OR OMMISSIONS DO NOT RELIEVE 10 THE APPLICANT FROM THE RESPONSIBILITY 'tits* OF'AS Burr COMPLANCE. atigh / DATE: ��UA e______ INSPECTOR 1 YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: CVS Pharmacy Remodel Address: 976 Rt 28 Contact Name: Jason Hunn Phone: 608-407-9087 Y NO NA Subject Regulation E S x Access for Fire Apparatus 527 CMR I; 18.2.4.1 x Building Numbers MGL Chapter 148;sec 59 -- x *Flammable gas/llquid storage 527 CMR I;42.2.2.1 _ x Fire Lanes 527 CMR I;22.3 x *Service Stations 527 CMR I ;16.2.3,16.2.3.1,30.3.2 x *Hazardous Materials Storage 527 CMR 1;60.1 x *Kitchen Exhaust Systems* 780 CMR,527 1;50.1 x Extinguishers 527 CMR I; 13.6,Chapter 148;sec 28 x Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;,527 CMR I; 13.7 x - *LPC Storage Chapter 148;sec 9,10,28&527 CMR l;69.1 x _ Use and Occupancy(FH Building Class) 780 CMR;302.1 x Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I x Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1 x *Upholstery 527 CMR 1;20.6.2.5 x *Trash Containers 527 CMR 1; 19.1.1, 1.12 x Any Hazard to the Public Chapter 148;sec 28 x *Curtains,Draperies,Blinds 527 CMR 1; 12.6.2 * YFD permit required-depending on occupancy and submittal *Per 780 CMR 901.5, contact Yarmouth Fire Department for acceptance test. *Per 527 CMR 1 13.1.8, a permit is required from the Fire Department to shut down any fire protection system. Description of planned project/other requirements: Interior remodel; Compliance with the following: 527 CMR 1 Chapter 16 "Safeguarding Construction, Alteration, and Demolition Operations." 527CMR1 Chapter 18 "Fire Department Access and Water Supply" Plan Reviewed Bypt A.wpector Date: d777/ Cs' Copy for Applicant Copy to Building Department I I Copy to Fire Prevention I I Entered in Firehouse n Final Inspection - 8 Letter of Transmittal • . st STATE PERMITS,INC. OMNI Steen 319 Elaines Ct.-Dodgeville,WI 53533 608/319-2096 * fax: 608/319-2011 www.st8.com Date: 6/28/2018 To: Town of Yarmouth 1146 Rt 28 South Yarmouth,MA 02664 Phone: (508) 398-2231 x1261 Attn: _RG 3 0. ' — - Re: CVS #735 Street Location 976 Main St. Route 28 South Yarmouth,MA Proj: 834000 We Transmit-VIA FED-EX Check#30298 Amount$35.00 Payable To: Town of South Yarmouth ITEMS : - BPA - GC License - GC Insurance These Are Transmitted : Remarks : Please call 608-407-9087 with questions.This is for a change of GC only to an approved permit. Signed:i ,77 Jason Hunn x417 Page 1 of 1 319 Elaines Ct.-Dodgeville,WI 53533 -608/319-2096-Fax:608/319-2011 -www.st8.com